New Year’s Eve and New Year’s Day always provide excellent opportunities for journalists to look, Janus-like, backwards into the recent past, and forward into the immediate future, and the flipping of the calendar from 2017 to 2018 is no exception.
The big-picture reality? As we enter 2018, the leaders of the most advanced multispecialty medical groups are absolutely skating to where the puck is headed in U.S. healthcare, leveraging data analytics, and aligning incentives, in order to take on increased risk in risk-bearing contracts. Indeed, for those who closely observed key trends in 2017, it has been clear that is those advanced physician organizations that are pointing the way, as we edge into 2018, facing an operating environment with accelerating policy, business, and IT-strategic challenges.
As Managing Editor Rajiv Leventhal reported in a December 13 article, “Medical groups and health systems that are members of AMGA (the American Medical Group Association) expect that nearly 60 percent of their revenues from Medicare will be from risk-based products by 2019, according to the results from a recent survey.” Leventhal noted that AMGA’s third annual risk survey, which encompassed complete responses from 74 of that association’s member medical groups, found that, “[I]f Medicare Advantage, bundled payments, Medicaid managed care organizations, and Medicare accountable care organizations (ACOs) are factored together, alternatives to Medicare fee-for-service (FFS) are predicted to account for 59 percent of AMGA member’s revenues by 2019, compared to 53 percent in 2017.”
Granted, AMGA’s member medical groups by and large represent the most advanced, as well as the largest, independent multispecialty medical groups operating in the U.S.; further, lumping Medicare Advantage contracts together with bundled-payment contracts and participation in the MSSP (Medicare Shared Savings Program) for ACOs is a bit facile. That said, the fact that the most sophisticated medical groups anticipate three-fifths of their revenues to come from risk, within the next year, is quite significant indeed.
Meanwhile, what did AMGA member-group executives cite as the number-one impediment to taking on risk? The white paper, entitled “Taking Risk, 3.0: Medical Groups Are Moving to Risk … Is Anyone Else? AMGA’s Third Annual Survey on Taking Risk,” noted that “The most critical obstacles involve data, particularly the lack of access to administrative claims data, health plan data that is not actionable, and reporting data to duplicative quality measurement programs. Internal impediments revolve around the need to develop and finance the infrastructure necessary to take risk.”
In our editorial team’s reporting, we’ve found consistently, in interviewing provider leaders over the past year, that a lot of really basic “blocking and tackling” elements of leveraging data—and especially of “marrying” clinical and claims data—remain core obstacles to improving performance in risk-based contracting. Indeed, that issue remains one of the biggest day-to-day problems for both hospital and medical group leaders moving into risk.
Perhaps that’s why the actual, practical planning for the implementation of artificial intelligence-based development work in patient care organizations has not yet reached the level of prioritization that might be expected. As Associate Editor Heather Landi reported on December 7, “A new survey provides some insight into how hospital and health system leaders are prioritizing healthcare technology investments for next year with strong indications that healthcare leaders are focused on investing in proven technology solutions that will have an immediate impact, and are proceeding cautiously with emerging technology like artificial intelligence (AI). The survey, conducted by the Pittsburgh-based Center for Connected Medicine (CCM) in partnership with the Health Management Academy, reflects the opinions of healthcare C-suite leaders from 20 major U.S. health systems across the country.”
Interviewing Gary Bisbee Jr., Ph.D., co-founder, chairman and CEO of the Health Management Academy, and Bryan Clutz, Ph.D., researcher director at the Academy and Melissa Stahl, research manager, about the implications of the survey’s findings, Landi wrote, “An overall emerging theme from the survey was that while health system leaders are excited about the prospects of emerging technologies such as AI and machine learning, yet the majority are proceeding cautiously on these technologies and continue to be focused, instead, on proven technologies and IT initiatives, such as enhancing existing electronic health record (EHR) systems, standardizing IT platforms and cybersecurity solutions.”
As the article noted, “[T]he survey found that more than half of health systems currently use AI, but 63 percent of hospital IT executives ranked the implementation of AI solutions as a ‘low’ or ‘very low’ priority for 2018. Executives reported that AI is in its early stages where proving its value is difficult and the technology still needs refinement, but they expect the technology to have greater impact in the future, according to the survey report. And, responding health systems expect to spend an average of 2.6 percent of their IT budget on AI in 2018.”
As Landi noted, “In the report, one CIO who was interviewed said: ‘I think that health care is still figuring out how to get value from data in general. We have use cases, but they are not ubiquitous. Until data is ubiquitous, it makes AI hard to prioritize. Additionally, it’s great to predict something but if you don’t have a corresponding intervention it doesn’t do much. It’s interesting, but still an experiment.’”
All of that makes a lot of sense, and speaks to where the industry really is right now—at an important inflection point, if a relatively early one, in the plunge towards the “deep end of the pool,” with regard to population health management and risk-based contracting.
As I noted in our July/August cover story, “[T]he leaders of more advanced medical groups… are already involved in taking on some level of financial risk in risk-based contracting, whether through federal accountable care organizations (ACOs) or ACOs sponsored by private health insurers, or through bundled-payment contracts (again, federal or private), or through any one or more of a broad range of population health-focused contracts of all kinds. And these medical group leaders have been spending the last few-to-several years learning how to collect and analyze data and use that data to feed continuous clinical and operational performance improvement, while at the same time building learning organizations, and transforming the physician cultures in their organizations.”
Jeffrey LeBenger, M.D., CEO of the Berkeley Heights, New Jersey-based Summit Medical Group, one of the most advanced medical groups of its kind in the U.S., put it very succinctly to me, when he said, ““Everybody says it’s population health, population health,” he says, referring to the current focus on population health management strategies. “To be honest, I think that’s a bit wrong. You have to look at your model of healthcare. We’re getting very close to 800 providers; we’re in seven counties. And what we’ve done is that we’ve created high-acuity urgent care centers with imaging and with specialists; and we’ve created high-risk clinics for our high-risk patients. We do transitions of care for our sickest 5 to 10 percent of patients. We have home healthcare. We have medical directors at 70 percent of the long-term facilities we’re in. We compensate based on outcomes. And we follow the patient-centered medical home concept; and we really manage the patients out of the hospitals. For us, a hospital is a center for tertiary or quaternary care. We look very closely at monitoring patients out of the hospital.”
In other words, put simply, Dr. LeBenger and his fellow physicians at Summit Medical Group are looking ahead to the future of U.S. healthcare, when multispecialty medical group-based care management will be the core of the focus of the healthcare system, particularly for patients with chronic conditions; and in which averting inpatient hospitalizations and emergency department visits, will be the norm, not the exception.
Analytics interest is surging—for good reason
Meanwhile, the leveraging of analytics to support population health management and care management appropriately leapt to the forefront in 2017. And that leveraging is getting more and more sophisticated. As Scott Hines, M.D., the chief quality officer at Crystal Run Healthcare, the 400-plus-physician group based in the Hudson Valley town of Middletown, New York, told me, in an interview for the same cover story, “When we were relying solely on the payers’ claims data, there was at least a three-month delay/lag,” he says. “So we asked for specific numerators and denominators from the payers, for each of their measures.” In this context, the denominator is the patients included in a measure, and the numerator is the subgroup of patients that the health plan involved has determined are compliant with a particular measure. “And we take that information and feed it into our payer quality scorecard, and that captures any internal data, and shows us where we are in real time on those measures. We’re trying not to have any surprises, so that the payer says, for example, your benchmark was 75 percent for breast cancer screening, and you only hit 72 percent—that kind of thing.”
In that regard, it should surprise no one that recent surveys have shown that healthcare CIOs are focusing on leveraging analytics in the near future.
As Heather Landi reported in a December 20 story, 40 percent of hospital CIOs surveyed by the Springfield, Va.-based Spok, on behalf of the Ann Arbor, Mich.-based CHIME (College of Healthcare Information Management Executives) indicated this summer that “deploying an enterprise analytics platform is a top priority in 2018. Seventy-one percent of respondents,” the survey found, “cited integrating with the EHR is a top priority, and 62 percent said physician adoption and buy-in for securing messaging was a top priority in the next 18 months. What’s more, 38 percent said optimizing EHR integration with other hospital systems with a key focus for 2018.”
Facing up to the cybersecurity-threat tsunami
All of these surveys speak to the reality that all of the trends in U.S. healthcare—with one exception—are heading in the same direction—around the collection, analysis, and sharing of data, in order to allow providers to participate successfully in risk-based contracting, population health management, and care management.
The one exception? The massive cybersecurity challenge, which is forcing healthcare IT leaders to think in the “opposite direction”—in terms of protecting PHI (protected health information) on behalf of patients, in the face of a rising tsunami of cyber threats from all sources.
As Rajiv Leventhal noted in a December 20 news story, a new report from Black Book has found that “More than eight in ten provider organizations lack a reliable enterprise leader for cybersecurity, while only 11 percent plan to get a cybersecurity officer in 2018.” Indeed, he reported, “The survey revealed that the healthcare industry continues to underestimate security threats as attackers continue to seek data and monetary gain, researchers attested. "The low security posture of most healthcare organizations may prove a target demographic for which these attacks are successful," said Doug Brown, managing partner of Black Book. What’s more, 92 percent of the C-suite officers surveyed stated that cybersecurity and the threat of data breach are still not major talking points with their board of directors. And 15 percent of all healthcare organizations responding to the survey said they are taking cybersecurity seriously by having a chief information security officer (CISO) in charge now.”
As Doug Brown, a managing partner at Black Book, was quoted as saying that “Cybersecurity has to be a top-down strategic initiative as it’s far too difficult for IT security teams to achieve their goals without the board leading the charge.”
And the growing danger is real: as Leventhal reported on December 13, “Eighty-three percent of physicians in a recent survey said that they have experienced some sort of cyber attack, such as phishing and viruses, while 55 percent of respondents said they are “very worried” about future cyber attacks on their organizations. This latest research on healthcare cybersecurity, from Accenture and the American Medical Association (AMA), surveyed 1,300 physicians across the U.S. this summer regarding their experiences and attitudes toward cybersecurity. The findings suggest ‘a strong need for improved cybersecurity education for physicians,’ according to the researchers.”
In a strange sort of way, those survey results take us back to the core trends, in that physicians in practice will increasingly be turning to CIOs, CMIOs, and other healthcare IT leaders in hospitals and health systems to help them meet confront their cybersecurity challenges, as the doctors in onesie-twosie practices are woefully unprepared for the cybersecurity tsunami.
And even smaller hospitals will increasingly turn to consolidation within large health systems in order to survive the massive cybersecurity challenge facing the industry.
Finally, one thing is absolutely clear: provider leaders face an increasingly challenging policy and payment landscape going into 2018. The comprehensive tax bill passed by Republicans in Congress and signed into law in December by President Trump, presages potentially significant Medicare reimbursement cuts, as the growth in the deficit occasioned by the tax cuts involved in the bill is emboldening some in Congress to push for Medicare cuts.
And with the ongoing aging of the U.S. population and the explosion in chronic conditions, there is no question whatsoever that federal policy leaders, including members of Congress, will push for new ways to control the inevitably growing cost of U.S. healthcare. So those provider leaders who are preparing to plunge more deeply into risk-based contracting, are absolutely skating to where the U.S. healthcare puck is inevitably headed.
In any case, best wishes to everyone, as we skate into 2018!